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A Pilot Study: Cardiac Parameters in Children Receiving New-Generation Antidepressants

Uchida, Mai MD*; Spencer, Andrea E. MD*; Kenworthy, Tara BA*; Chan, James MA*; Fitzgerald, Maura MPH*; Rosales, Ana Maria MD; Kagan, Elana BA*; Saunders, Alexandra BA*; Biederman, Joseph MD*

Journal of Clinical Psychopharmacology: June 2017 - Volume 37 - Issue 3 - p 359–362
doi: 10.1097/JCP.0000000000000683
Brief Reports

Objective Because of concerns about potential associations between high doses of citalopram and QTc prolongation in adults, this study examined whether such associations are operant in children. We hypothesized that therapeutic doses of nontricyclic antidepressant medications (non-TCAs) prescribed to children would be cardiovascularly safe.

Study Design The sample consisted of 49 psychiatrically referred children and adolescents 6 to 17 years old of both sexes treated with a non-TCA (citalopram, escitalopram, fluoxetine, paroxetine, sertraline, bupropion, duloxetine, venlafaxine, mirtazapine). To standardize the doses of different antidepressants, we converted doses of individual medicines into “citalopram equivalent doses” (CEDs) based on dosing recommendation for individual antidepressants. Correlation analysis was carried out to compare the continuous and weight-based CED to variables of interest. A QTc grouping was defined as normal, borderline, or abnormal, and CED was compared across QTc groupings using linear regression. An antidepressant dosage group was defined as low or high dose, and a t test compared variables of interest across dosage groups.

Results No significant associations were found between total or weight-corrected CEDs of any antidepressant examined and QTc or any other electrocardiogram or blood pressure parameters. In patients taking citalopram or escitalopram, a significant correlation was found between PR interval and total daily dose, which disappeared when weight-based doses were used or when corrected by age.

Conclusions Although limited by a relatively small sample size, these results suggest that therapeutic doses of non-TCA antidepressants when used in children do not seem to be associated with prolonged QTc interval or other adverse cardiovascular effects.

From the *Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital; and †Pediatric Cardiology, Massachusetts General Hospital for Children, Boston, MA.

Received June 24, 2016; accepted after revision February 3, 2017.

Reprints: Mai Uchida, MD, 55 Fruit St, Warren 625, Boston, MA 02114 (e-mail:

M.U. and A.E.S. are co-first authors.

The initial draft was written by Drs Mai Uchida and Andrea Spencer.

This study was supported in part by the Pediatric Psychopharmacology Council Fund.

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.